Pathway analysis for providing predictive information

ABSTRACT

A method for assigning ranking scores to pathways in a set of pathways for classifying patients is disclosed. The method comprises the steps of comparing biomolecular datasets from different groups of patients and performing an analysis in order to assign ranking scores to pathways in a set of pathways. Furthermore, a method for using cancer pathway evaluation to support clinical decision making is disclosed. This assessment is further used for stratifying ovarian cancer patients based on chemosensitivity to platinum based drugs, the standard chemotherapy. We present the method for evaluation and ranking of the most relevant pathways responsible for platinum sensitivity. Clinical decision support software system should be able to then visualize this information for a clinician, contextualize it within a patient data set and help make a final decision on the potential responsiveness.

FIELD OF THE INVENTION

The present invention relates to a method for pathway analysis, and more particularly to a method, an assay, a clinical decision support system and a computer program product for pathway analysis for providing predictive information in relation to cancer.

BACKGROUND OF THE INVENTION

Ovarian cancer is the most lethal of all gynaecological cancers due to its late diagnosis, high mortality and low 5-year survival rates. Reasons for this poor outcome include non specific presenting symptoms and identification in advanced stages of disease, mainly due to there being no reliable screening methods for early detection. Ovarian cancer is the 6th most common cancer world-wide with 204,000 cases and 125,000 deaths worldwide. The exact cause of developing ovarian cancer is still unknown; however, women with certain risk factors may be more likely than others to develop ovarian cancer. The top ranking factors include age, parity (like for breast cancer), personal and drug history. For the approximately 10% of familial linked ovarian cancer, mutations in BRCA1 and BRCA2 appear to be responsible for disease in 45% of families with multiple cases of breast cancer only, and in up to 90% of families with both breast and ovarian cancer. An Open Access On-Line Breast Cancer Mutation Data Base serves as a repository for over 2,000 distinct mutations and sequence variations in BRCA1 and BRCA2.

There is evidence in the medical literature about the role of DNA Methylation in cancer.

The highest sensitivity for hypermethylation is detected in the following genes: CDKN2A, PCSK6, OPCML, SFN, CTCF, ESR1, DLEC1, RASSF1A, GATA4, RUNX3, WT1, MYOD1, and PYCARD. Although less frequent, there are also genes that are hypomethylated and overexpressed in cancer samples, and are potential oncogenes. Synucleins are a family of small cytoplasmic proteins that are expressed predominantly in neurons and retina. In a group of SNCG mRNA-expressing tumours, there were 75.7% (25 of 33) cases with hypomethylated or demethylated exon 1 of SNCG. The genes include synuclein-gamma (SNCG). Hypomethylation of the RHOA promoter region in tumour DNA was observed two times more frequently than increased methylation.

Regarding predicting treatment response, information about how a cancer develops through molecular events could allow a clinician to predict more accurately how such a cancer is likely to respond to specific therapeutic treatments. In this way, a regimen based on knowledge of the tumour's sensitivity can be rationally designed. Thus, characterization of a cancer patient in terms of predicting treatment outcome enables the physician to make an informed decision as to a therapeutic regimen with appropriate risk and benefit trade-offs to the patient.

In terms of diagnosis, the key to improving the clinical outcome in patients with cancer is diagnosis at its earliest stage, while it is still localized and readily treatable. The characteristics noted above provide means for a more accurate screening and surveillance program by identifying higher-risk patients on a molecular basis. It could also provide justification for more definitive follow up of patients who have molecular but not yet all the pathological or clinical features associated with malignancy.

US20090011049 is related to the area of cancer prognosis and therapeutics. In particular, it relates to aberrant methylation patterns of particular genes in cancers. For example, the silencing of nucleic acids encoding a DNA repair or DNA damage response enzyme can be used prognostically and for selecting treatments that are well tailored for an individual patient. Combinations of these markers can also be used to provide prognostic information.

While there are many genes reported to be differentially hypermethylated in ovarian cancer, currently there is still a need for methods which are able to predict a course of events for patients suffering from or being examined for ovarian cancer. For example, there are no diagnostic methods which are able to predict therapy response to platinum based drugs. The primary chemotherapy agents used in the treatment of ovarian cancer are cisplatin and carboplatin. The mechanism of platinum sensitivity is still not well understood in the literature. We need clinical tools that will assess early resistance to platinum so that the patients can be given alternative therapy choices with higher chance of better outcome.

Hence, an improved method for providing prognostic information would be advantageous, and in particular a method for providing prognostic information earlier, more efficiently and/or more reliably would be advantageous.

SUMMARY OF THE INVENTION

In particular, it may be seen as an object of the present invention to provide a method that solves the above mentioned problems of the prior art with the inability to provide predictive information at an early stage, such as being able to predict therapy response to platinum based drugs at an early stage.

It is a further object of the present invention to provide an alternative to the prior art.

Thus, the above described object and several other objects are intended to be obtained in a first aspect of the invention by providing a method for assigning ranking scores to pathways in a set of pathways for classifying subjects, said method comprising the steps of

-   -   obtaining a plurality of primary datasets comprising         biomolecular features from a plurality of primary subjects,     -   obtaining a plurality of secondary datasets comprising         biomolecular features from a plurality of secondary subjects,     -   identifying a clinical parameter, where the clinical parameter         is a parameter relevant to cancer and which has different values         for the primary subjects and the secondary subjects,     -   identifying a plurality of stratifying features in the primary         and secondary datasets which stratify the primary and secondary         subjects,     -   identifying a plurality of stratifying genes corresponding to         the stratifying features,     -   assigning a ranking score to each pathway in the set of pathways         thereby providing a set of ranked pathways, said ranking being         based upon the plurality of stratifying genes.

The invention is particularly, but not exclusively, advantageous for enabling a physician to classify a sample, such as sensitive and resistant samples, such as normal and tumour samples, based on datasets comprising biomolecular data. The invention provides a tool for biological understanding. This approach relies not only on individual genes, but involves pathway analysis. It is important to have the tools for biological understanding such as pathway analysis to be applied in, for example chemosensitivity, when making therapy plans for cancer patients.

The various steps of the invention may in certain instances be interchanged or combined as is understandable from the principles of the invention.

In an advantageous embodiment, the invention may be utilized for visualization of stratifying genes within a plurality of pathways. In a particularly advantageous embodiment, the visualization may further be based on biomolecular data being obtained from a patient or a sample.

As used herein the term “expression” shall be taken to mean the transcription and translation of a gene. “Expression” or lack thereof is often also a consequence of epigenetic modifications of the genomic DNA associated with the marker gene and/or regulatory or promoter regions thereof. Genetic modifications include SNPs, point mutations, deletions, insertions, repeat length, rearrangements, copy number variations and other polymorphisms. The analysis of either the expression levels of protein, or mRNA expression are summarized as the analysis of ‘expression’ of the gene. Also, the analysis of the patient's individual genetic or epigenetic modification of the marker gene can have impact on “expression”.

In the context of the present invention the term “chemotherapy” is taken to mean the use of pharmaceutical or chemical substances to treat cancer.

In the context of the present invention the term “regulatory region” of a gene is taken to mean nucleotide sequences which affect the expression of a gene. Said regulatory regions may be located within, proximal or distal to said gene. Said regulatory regions include but are not limited to constitutive promoters, tissue-specific promoters, developmental-specific promoters, inducible promoters, as well as noncoding RNAs (such as microRNAs) and the like. Promoter regulatory elements may also include certain enhancer sequence elements that control transcriptional or translational efficiency of the gene. These sequences can have various levels of binding specificity and can bind to so called transcription factors as well as DNA methyl-binding proteins, such as MeCP, Kaiso, MBD1-MBD4.

In the context of the present invention, the term “methylation” refers to the presence or absence of 5-methylcytosine (“5-mCyt”) at one or a plurality of CpG dinucleotides within a DNA sequence.

In the context of the present invention the term “methylation state” is taken to mean the degree of methylation present in a nucleic acid of interest, this may be expressed in absolute or relative terms i.e. as a percentage or other numerical value or by comparison to another tissue and therein described as hypermethylated, hypomethylated or as having significantly similar or identical methylation status.

In the context of the present invention, the term “hypermethylation” refers to the average methylation state corresponding to an increased presence of 5-mCyt at one or a plurality of CpG dinucleotides within a DNA sequence of a test DNA sample, relative to the amount of 5-mCyt found at corresponding CpG dinucleotides within a normal control DNA sample.

In the context of the present invention, the term “hypomethylation” refers to the average methylation state corresponding to a decreased presence of 5-mCyt at one or a plurality of CpG dinucleotides within a DNA sequence of a test DNA sample, relative to the amount of 5-mCyt found at corresponding CpG dinucleotides within a normal control DNA sample.

In the context of the present invention, the term “methylation assay” refers to any assay for determining the methylation state of one or more CpG dinucleotide sequences within a sequence of DNA.

In the context of the present invention, the term “pathway” refers to the set of interactions occurring between a group of genes, which genes depend on each other's individual functions in order to make the aggregate function of the network available to the cell.

In the context of the present invention, the term “biomolecular features” refers to a set of features which are of biomolecular character, such as a set of levels of gene expression or a set of DNA methylation levels.

In the context of the present invention, the term “primary subjects” refers to a group of subjects, such as mammals, such as humans, such as patients, such as samples, which are distinguished form a corresponding group of “secondary subjects” in that they can be associated with one or a combination of clinical parameters which differ between the primary and secondary subjects.

In the context of the present invention, the term “secondary subjects” refers to a group of subjects, such as mammals, such as humans, such as patients, such as samples, which are distinguished form a corresponding group of “primary subjects” in that they can be associated with one or a combination of clinical parameters which differ between the primary and secondary subjects.

In the context of the present invention, the term “primary datasets” refers to datasets derived from primary subjects, which datasets comprise biomolecular features.

In the context of the present invention, the term “secondary datasets” refers to datasets derived from secondary subjects, which datasets comprise biomolecular features.

In the context of the present invention, the term “clinical parameter” refers to one of a set of measurable factors, such as grade, hormone receptor status, that characterizes a patient and can contribute to the presentation of the disease. The clinical parameter may be any one or a combination of p53 status, ER status, grade, stage and a sensitivity towards the therapy comprising one or more platinum based drugs, such as platinum free interval.

In the context of the present invention, the term “stratifying features” refers to biomolecular features which differ in a statistically significant manner between the primary and secondary datasets.

In the context of the present invention, the term “stratifying genes” refers to genes which comprise stratifying features, i.e., genes which separate primary and secondary subjects.

In the context of the present invention, the term “ranking score” refers to a score representing a numerical value.

In the context of the present invention, the term “node” refers to a gene in a pathway.

In the context of the present invention, the term “connection” refers to the informational interactions between nodes in a pathway.

In the context of the present invention, the term “hub” represents a node with a number of connections being larger than an average number of connections per node in a given pathway.

In the context of the present invention, the term “important hub” represents a hub with a number of connections being larger than an average number of connections per node in a given pathway.

In the context of the present invention, the term “functional node” refers to a node in a pathway which is also a stratifying gene.

In the context of the present invention, the term “significance value” refers to the use of p-value where lower p-value, corresponds to a less likely chance that the null hypothesis is true, and consequently the result is more “significant” in the sense of statistical significance.

In the context of the present invention, the term “subject classification score” refers to a numerical value based on the difference between database values of stratifying features and values of corresponding features in the subject dataset. The subject classification score corresponds to a quantitative classification of the subject.

According to a second aspect of the invention, the invention further relates to an assay for analysing target nucleic acids comprising one or a combination of the genes taken from a group consisting of stratifying genes according to the first aspect, and their regulatory regions by contacting at least one of said target nucleic acids in a biological sample obtained from a subject.

This aspect of the invention is particularly, but not exclusively, advantageous in that the assay according to the present invention may be implemented by immobilizing gene sequences complimentary to said taken from the group consisting of stratifying genes according to the first aspect, and their regulatory regions onto glass-slides or other solid support followed by hybridization of labelled, such as fluorescently labelled, such as radioactively labelled, or otherwise labelled nucleic acids derived from the biological sample obtained form a subject (comprising the sequences to be interrogated) to the known genes immobilized on the glass-slide. After hybridization, arrays are scanned, such as using a fluorescent microarray scanner. Analyzing the relative intensity, such as fluorescent intensity, of different genes provides a measure of the differences in gene expression.

In an alternative embodiment of the invention nucleic acid methylation detection is performed using methylation specific PCR or methylation specific sequencing to assess the level of DNA methylation

According to a third aspect of the invention, the invention further relates to a method for classifying a subject, said method comprising

-   -   obtaining a subject dataset comprising biomolecular data, such         as gene expression data or DNA methylation pattern data, of a         target nucleic acid comprising one or a combination of the genes         taken from a group consisting of stratifying genes according to         claim 1 and their regulatory regions,     -   identifying the pathway according to claim 1, which is assigned         the highest ranking score,     -   accessing a database comprising database values of the         stratifying features corresponding to hubs according to claim 1,     -   calculating a subject classification score based on the         difference between database values of the stratifying features         corresponding to hubs and values of corresponding features in         the subject dataset.

This aspect of the invention is particularly, but not exclusively, advantageous in that the method according to the present invention may be implemented by means of a processor adapted to carry out the method.

According to a fourth aspect of the invention, the invention further relates to a clinical decision support system comprising

-   -   an input for providing a subject dataset comprising biomolecular         data, such as gene expression or methylation pattern, of a         target nucleic acid comprising one or a combination of the genes         taken from a group consisting of stratifying genes according to         claim 1 and their regulatory regions,     -   a computer program product for enabling a processor to carry out         the method of claim 15,     -   an output for outputting the subject classification score.         This aspect of the invention is particularly, but not         exclusively, advantageous in that the clinical decision support         system according to the present invention may be implemented by         software shown on a workstation, or a handheld computer, or         phone, that shows the values for, for example differentially         methylated pathways, potentially along with other clinical         parameters obtained from the patient. In one specific example,         significantly deregulated pathways may be shown. A Clinical         decision support system according to an embodiment of the         invention may be utilized in order to evaluate candidate         pathways for carboplatinum based therapy in adjuvant setting for         ovarian cancer patients. If a patient is found to be resistant         due to de-regulated PI3K pathway, PI3K inihibitors could be         administered to offset the deregulation and help the patient         become more responsive to chemotherapy. In a particular         embodiment, the output may further include the activity levels         and deregulation with respect to normals, resistant to therapy         and sensitive to chemotherapy of different pathways.

According to a fifth aspect of the invention, the invention further relates to a computer program product for enabling a processor to carry out the method according to the third aspect.

The first, second, third, fourth and fifth aspect of the present invention may each be combined with any of the other aspects. These and other aspects of the invention will be apparent from and elucidated with reference to the embodiments described hereinafter.

BRIEF DESCRIPTION OF THE FIGURES

The method, assay, clinical support system and computer program product according to the invention will now be described in more detail with regard to the accompanying figures. The figures show one way of implementing the present invention and is not to be construed as being limiting to other possible embodiments falling within the scope of the attached claim set.

FIG. 1 shows clinical data: Platinum Free Interval (PFI) for all samples,

FIG. 2 shows hierarchical clustering of all loci after a t-test (p-value 0.05) and fold change >1.1,

FIG. 3 shows the Wnt Pathway and functional nodes that are important in determining response to chemosensitivity,

FIG. 4 shows -PI3K-akt pathway and functional nodes that are important in determining response to chemosensitivity,

FIG. 5 shows the PDGF signalling pathway and functional nodes that are deemed significant in tumor vs. normal analysis,

FIG. 6 is a flow-chart of a method according to an embodiment of the invention.

DETAILED DESCRIPTION OF AN EMBODIMENT

In a further embodiment the invention relates to a method, wherein assigning ranking scores to pathways in a set of pathways further includes the step of assigning a ranking score to each pathway in the set of pathways comprises calculating a significance value for each pathway, said significance value being based upon a number of common genes between the plurality of stratifying genes and the pathway.

The significance value may be a p-value based on the Hypergeometric distribution or Fisher's exact test.

In one particular embodiment, the step of the step of assigning a ranking score to each pathway in the set of pathways comprises calculating a value based on gene overlap with stratifying genes. In an exemplary embodiment, the calculation of a significance value may be performed according to the following example. Suppose you have N genes, where N would be the number of genes in a chip, such as a chip used for generating primary and secondary datasets. M genes are annotated to a specific pathway in the set of pathways. n genes are found to be in the input list, such as comprised within the stratifying genes, for example differentially methylated. k represents the number of genes from the input list which are also annotated to the specific pathway. The probability for any given k, where k is an integer in the set of integers from 1 to n, can then be calculated according to the formula:

$\begin{matrix} {h\left( {{k\left. {N;M;n} \right)}:={{P\left( {X = k} \right)} = \frac{\begin{pmatrix} M \\ k \end{pmatrix}\begin{pmatrix} {N - M} \\ {n - k} \end{pmatrix}}{\begin{pmatrix} N \\ n \end{pmatrix}}}} \right.} & \left( {{Eq}.\mspace{11mu} 1} \right) \end{matrix}$

In one other specific embodiment, the step of identifying a plurality of stratifying genes based on the stratifying features comprises the steps

-   -   performing a statistical analysis,     -   performing a classification, such as clustering.

In a further embodiment the invention relates to a method, wherein the step of assigning a ranking score to each pathway in the set of pathways comprises the steps of

-   -   identifying a number of functional nodes in a pathway, the         functional nodes being nodes corresponding to stratifying genes,     -   identifying a number of hubs in the pathway, the hubs being         nodes with a number of connections being larger than an average         number of connections per node in the pathway,     -   identifying a number of important hubs in the pathway, the         important hubs being hubs with a number of connections being         larger than an average number of connections per node in the         pathway,     -   assigning a ranking score to the pathway, the ranking score         being based upon a ratio between the number of functional nodes         and a number of nodes and a ratio between the number of         important hubs and the number of hubs.

An advantage of such embodiment may be that it can be implemented in a straightforward manner, and that the identification of functional nodes, hubs and important hubs may be simultaneously used for other purposes. In particular, the hubs may be used as indicators, so that a value to be used in a clinical setting, can be calculated by calculating the difference compared to hub values in biomolecular data obtained from a patient sample.

In a particular embodiment, the set of pathways and functional nodes may comprise any one of the pathways and genes given in Table I.

TABLE I Chromosome strand m(-), Gene ProbeID Fragment Num. Start End p(+) Resistant vs. Sensitive analysis akt pathway and wnt signalling pathway GSK3B 101331.594.482 MspFrag28471_3_121297088_121297216 3 121297088 121297216 m FZD1 203279.320.922 MspFrag56995_7_90539644_90539897 7 90539644 90539897 p CTNNB1 92989.616.164 MspFrag25957_3_41213549_41215233 3 41213549 41215233 p Androgen receptor pathway COX5B 66677.156.156 MspFrag18685_2_97721039_97721183 2 97721039 97721183 p PXN 340153.701.293 MspFrag95061_12_119164784_119165946 12 119164784 119165946 m POU2F1 38114.196.208 MspFrag10698_1_163921158_163921341 1 163921158 163921341 p CCNE1 494022.258.1004 MspFrag137132_19_34995425_34995795 19 34995425 34995795 p TMF1 98978.256.430 MspFrag27675_3_69183942_69184077 3 69183942 69184077 m TMF1 98985.584.264 MspFrag27677_3_69184229_69184352 3 69184229 69184352 m MAPK1 541414.423.597 MspFrag150099_22_20545088_20545893 22 20545088 20545893 m PTEN 280194.192.1014 MspFrag78241_10_89612949_89613050 10 89612949 89613050 p NCOA3 523517.757.145 MspFrag145248_20_45563978_45564099 20 45563978 45564099 p gata3 and cytokine gene expression pathway GATA3 268815.345.897 MspFrag74963_10_8137298_8137588 10 8137298 8137588 p NFATC1 468453.516.496 MspFrag130462_18_75255770_75256048 18 75255770 75256048 p NFATC1 468492.428.622 MspFrag130473_18_75257144_75257310 18 75257144 75257310 p NFATC1 468505.763.77 MspFrag130476_18_75257628_75257866 18 75257628 75257866 p PTX2 CCND2 323251.49.807 MspFrag90182_12_4251165_4251361 12 4251165 4251361 p Normal vs. Tumor analysis granzyme-mediated apoptosis pathway HMGB2 131605.541.163 MspFrag37005_4_174630489_174630980 4 174630489 174630980 m SET 258150.210.34 MspFrag72158_9_128531004_128531190 9 128531004 128531190 p APEX1 358348.624.922 MspFrag100127_14_19993268_19993856 14 19993268 19993856 p DFFB 5613.251.385 MspFrag1575_1_3796892_3797034 1 3796892 3797034 p Basic mechanism of action of ppara pparb effects on gene expression PPARD 169972.513.129 MspFrag47672_6_35418307_35418428 6 35418307 35418428 p PPARG 89713.688.826 MspFrag24948_3_12304080_12304212 3 12304080 12304212 p IFN a signalling pathway STAT1 78675.465.377 MspFrag22031_2_191704463_191704563 2 191704463 191704563 m STAT2 331937.18.838 MspFrag92695_12_55040260_55040515 12 55040260 55040515 m Phosphoinosidtides and their downstream targets PRKC2 PLCG1 521868.549.775 MspFrag144778_20_39198472_39198934 20 39198472 39198934 p GSK3B 101319.720.720 MspFrag28469_3_121296382_121296760 3 121296382 121296760 m PRKCE 58777.69.739 MspFrag16462_2_45790699_45790818 2 45790699 45790818 p GRASP 329986.258.986 MspFrag92184_12_50687432_50687714 12 50687432 50687714 p Rho-selective guanine exchange factor akap13 mediates stress fiber formation RHOA 95515.752.164 MspFrag26652_3_49424481_49424611 3 49424481 49424611 m AKAP13 389484.262.430 MspFrag108956_15_83724178_83724944 15 83724178 83724944 p tpo signalling pathway RAF1 89805.297.451 MspFrag24971_3_12680778_12680878 3 12680778 12680878 m PIOG1 STAT1 78676.311.47 MspFrag22031_2_191704463_191704563 2 191704463 191704563 m STAT1 78675.465.377 MspFrag22031_2_191704463_191704563 2 191704463 191704563 m STAT1 78674.272.40 MspFrag22031_2_191704463_191704563 2 191704463 191704563 m STAT1 78664.744.82 MspFrag22027_2_191703584_191704171 2 191703584 191704171 m FOS 367165.85.551 MspFrag102666_14_74816034_74816285 14 74816034 74816285 p inactivation of gsk3 by akt causes accumulation of b-catenin in alveolar macrophages LEFT 126420.93.619 MspFrag35600_4_109446333_109446482 4 109446333 109446482 m LRP6 324917.684.126 MspFrag90666_12_12311610_12311770 12 12311610 12311770 m FZD1 203266.473.881 MspFrag56993_7_90539178_90539501 7 90539178 90539501 p FZD1 203271.513.773 MspFrag56993_7_90539178_90539501 7 90539178 90539501 p FZD1 203292.356.858 MspFrag56997_7_90540210_90540369 7 90540210 90540369 p FZD1 203272.168.648 MspFrag56993_7_90539178_90539501 7 90539178 90539501 p FZD1 203270.250.18 MspFrag56993_7_90539178_90539501 7 90539178 90539501 p WNT1 328477.74.612 MspFrag91771_12_47659447_47659639 12 47659447 47659639 p wnt signalling GSK3B 101331.594.482 MspFrag28471_3_121297088_121297216 3 121297088 121297216 m PPARD 169972.513.129 MspFrag47672_6_35418307_35418428 6 35418307 35418428 p FZD1 203266.473.881 MspFrag56993_7_90539178_90539501 7 90539178 90539501 p FZD1 203271.513.773 MspFrag56993_7_90539178_90539501 7 90539178 90539501 p FZD1 203292.356.858 MspFrag56997_7_90540210_90540369 7 90540210 90540369 p LRP6 324917.684.126 MspFrag90666_12_12311610_12311770 12 12311610 12311770 m MAP3K7IPI pdgf signalling pathway RAF1 89798.41.889 MspFrag24968_3_12680296_12680502 3 12680296 12680502 m RAF1 89797.225.805 MspFrag24968_3_12680296_12680502 3 12680296 12680502 m FOS 367165.85.551 MspFrag102666_14_74816034_74816285 14 74816034 74816285 p FOS 367163.332.420 MspFrag102666_14_74816034_74816285 14 74816034 74816285 p PLCG1 521883.758.704 MspFrag144783_20_39199366_39199498 20 39199366 39199498 p STAT1 78676.311.47 MspFrag22031_2_191704463_191704563 2 191704463 191704563 m PDGFRA 122302.371.217 MspFrag34299_4_54934710_54935346 4 54934710 54935346 p

In a specific embodiment, the ranking may depend on the presence of sub-networks, whereby is to be understood the particular configuration of the functional nodes. In a particular example, it could be that certain sub-networks (i.e. collection of functional nodes) are enriched in certain clinical parameters from a database. Then, pathways containing such enriched sub-networks may be assigned a relatively high ranking score.

In a further embodiment the invention relates to a method for discriminating between normal and tumour samples in cancer diagnostics, wherein the clinical parameter describes a presence of a tumour.

In a further embodiment the invention relates to a method for discriminating between normal and tumour samples in ovarian cancer diagnostics, wherein the clinical parameter describes a presence of a tumour in an ovary. In a further embodiment, the set of pathways includes any one of the pathways in Table II.

TABLE II Tumor vs. Normal Analysis Entities in Matched Matched Pathway Pathway with Chip with InputList pValue granzyme a mediated apoptosis pathway 12 9 4 0.011451 basic mechanism of action of ppara pparb(d) and pparg and effects on gene 11 2 2 0.011977 expression rho-selective guanine exchange factor akap13 mediates stress fiber formation 11 2 2 0.011977 pdgf signaling pathway 33 14 5 0.013389 effects of calcineurin in keratinocyte differentiation 18 6 3 0.020292 wnt signaling pathway 33 21 6 0.021729 phosphoinositides and their downstream targets 26 16 5 0.024284 visceral fat deposits and the metabolic syndrome 16 3 2 0.033312 ifn alpha signaling pathway 12 3 2 0.033312 phospholipase c-epsilon pathway 26 3 2 0.033312 multi-step regulation of transcription by pitx2 35 18 5 0.039652 tpo signaling pathway 30 13 4 0.045561 inhibition of cellular proliferation by gleevec 21 13 4 0.045561 nfat and hypertrophy of the heart 56 19 5 0.049124 inactivation of gsk3 by akt causes accumulation of b-catenin in alveolar 40 19 5 0.049124 macrophages

In a further embodiment the invention relates to a method for predicting responsiveness of a subject with ovarian cancer to a therapy comprising one or more platinum based drugs, wherein the clinical parameter describes a sensitivity towards the therapy comprising one or more platinum based drugs. In a further embodiment, the set of pathways includes any one of the pathways in Table III.

TABLE III Chemosensitivity Analysis Entities in Matched Matched Pathway Pathway with chip withInputList pValue AndrogenReceptor 98 72 9 0.001628 multi-step regulation of transcription by pitx2 35 18 4 0.00424 gata3 participate in activating the th2 cytokine genes expression 16 7 2 0.027084 segmentation clock 32 18 3 0.029722 PI3K-akt (inactivation of gsk3 by akt causes accumulation of b-catenin 40 19 3 0.034319 in alveolar macrophages) Leukocyte transendothelial migration 36 9 2 0.04414 phosphorylation of mek1 by cdk5/p35 down regulates the map kinase 17 9 2 0.04414 pathway Wnt signaling pathway 33 21 3 0.044541

In a further embodiment the invention relates to a method wherein the ranking score is given by a sum of

-   -   a ratio between the number of functional nodes and the number of         nodes,     -   a ratio between the number of important hubs and the number of         hubs,     -   a gene set enrichment score,         wherein the gene set enrichment score is based upon a comparison         of the functional nodes and a gene set comprising genes related         to the clinical parameter, the gene set enrichment score being         indicative of a probability of having the number of functional         nodes appearing in a database consisting of clinically relevant         genes. The gene set enrichment score can be a p-value based on         the Hypergeometric distribution or Fisher's Exact test.

In a further embodiment the invention relates to a method wherein the primary and secondary datasets comprise any one of: a DNA methylation dataset, a gene expression dataset. In a further embodiment, the genes may represent one or more sequences selected from the group consisting of SEQ ID NO: 1-42 (cf. Table IV).

TABLE IV Chr Gene Probe Fragment # Start DFFB 5613.251.385 MspFrag1575_1_3796892_3797034 1 3796892 POU2F1 38114.196.208 MspFrag10698_1_163921158_163921341 1 163921158 PRKCE 58777.69.739 MspFrag16462_2_45790699_45790818 2 45790699 COX5B 66677.156.156 MspFrag18685_2_97721039_97721183 2 97721039 STAT1 78664.744.82 MspFrag22027_2_191703584_191704171 2 191703584 STAT1 78675.465.377 MspFrag22031_2_191704463_191704563 2 191704463 PPARG 89713.688.826 MspFrag24948_3_12304080_12304212 3 12304080 RAF1 89798.41.889 MspFrag24968_3_12680296_12680502 3 12680296 RAF1 89805.297.451 MspFrag24971_3_12680778_12680878 3 12680778 CTNNB1 92989.616.164 MspFrag25957_3_41213549_41215233 3 41213549 RHOA 95515.752.164 MspFrag26652_3_49424481_49424611 3 49424481 TMF1 98978.256.430 MspFrag27675_3_69183942_69184077 3 69183942 TMF1 98985.584.264 MspFrag27677_3_69184229_69184352 3 69184229 GSK3B 101319.720.720 MspFrag28469_3_121296382_121296760 3 121296382 GSK3B 101331.594.482 MspFrag28471_3_121297088_121297216 3 121297088 PDGFRA 122302.371.217 MspFrag34299_4_54934710_54935346 4 54934710 LEF1 126420.93.619 MspFrag35600_4_109446333_109446482 4 109446333 HMGB2 131605.541.163 MspFrag37005_4_174630489_174630980 4 174630489 PPARD 169972.513.129 MspFrag47672_6_35418307_35418428 6 35418307 FZD1 203266.473.881 MspFrag56993_7_90539178_90539501 7 90539178 FZD1 203279.320.922 MspFrag56995_7_90539644_90539897 7 90539644 FZD1 203292.356.858 MspFrag56997_7_90540210_90540369 7 90540210 SET 258150.210.34 MspFrag72158_9_128531004_128531190 9 128531004 GATA3 268815.345.897 MspFrag74963_10_8137298_8137588 10 8137298 PTEN 280194.192.1014 MspFrag78241_10_89612949_89613050 10 89612949 CCND2 323251.49.807 MspFrag90182_12_4251165_4251361 12 4251165 LRP6 324917.684.126 MspFrag90666_12_12311610_12311770 12 12311610 WNT1 328477.74.612 MspFrag91771_12_47659447_47659639 12 47659447 GRASP 329986.258.986 MspFrag92184_12_50687432_50687714 12 50687432 STAT2 331937.18.838 MspFrag92695_12_55040260_55040515 12 55040260 PXN 340153.701.293 MspFrag95061_12_119164784_119165946 12 119164784 APEX1 358348.624.922 MspFrag_1_00127_14_19993268_19993856 14 19993268 FOS 367165.85.551 MspFrag102666_14_74816034_74816285 14 74816034 AKAP13 389484.262.430 MspFrag_1_08956_15_83724178_83724944 15 83724178 NFATC1 468453.516.496 MspFrag130462_18_75255770_75256048 18 75255770 NFATC1 468492.428.622 MspFrag130473_18_75257144_75257310 18 75257144 NFATC1 468505.763.77 MspFrag130476_18_75257628_75257866 18 75257628 CCNE1 494022.258.1004 MspFrag137132_19_34995425_34995795 19 34995425 PLCG1 521868.549.775 MspFrag144778_20_39198472_39198934 20 39198472 PLCG1 521883.758.704 MspFrag144783_20_39199366_39199498 20 39199366 NCOA3 523517.757.145 MspFrag145248_20_45563978_45564099 20 45563978 MAPK1 541414.423.597 MspFrag150099_22_20545088_20545893 22 20545088 Seq ID Gene End Strand NCBI_transcriptID NCBI_proteinID NO DFFB 3797034 p NM_004402.2 NP_004393.1 1 POU2F1 163921341 p NM_002697.2 NP_002688.2 2 PRKCE 45790818 p NM_005400.2 NP_005391.1 3 COX5B 97721183 p NM_001862.2 NP_001853.2 4 STAT1 191704171 m NM_007315.3 NP_009330.1 5 STAT1 191704563 m 6 PPARG 12304212 p NM_005037.5 NP_005028.4 7 RAF1 12680502 m NM_002880.3 NP_002871.1 8 RAF1 12680878 m 9 CTNNB1 41215233 p NM_007614.3 NP_031640.1 10 RHOA 49424611 m NM_001664.2 NP_001655.1 11 TMF1 69184077 m NM_007114.2 NP_009045.2 12 TMF1 69184352 m 13 GSK3B 121296760 m NM_002093.3 NP_002084.2 14 GSK3B 121297216 m 15 PDGFRA 54935346 p NM_006206.4 NP_006197.1 16 LEF1 109446482 m NM_016269.4 NP_057353.1 17 HMGB2 174630980 m NM_002129.3 NP_002120.1 18 PPARD 35418428 p NM_006238.4 NP_006229.1 19 FZD1 90539501 p NM_003505.1 NP_003496.1 20 FZD1 90539897 p 21 FZD1 90540369 p 22 SET 128531190 p NM_001122821.1 NP_001116293.1 23 GATA3 8137588 p NM_001002295.1 NP_001002295.1 24 PTEN 89613050 p NM_000314.4 NP_000305.3 25 CCND2 4251361 p NM_001759.3 NP_001750.1 26 LRP6 12311770 m NM_002336.2 NP_002327.2 27 WNT1 47659639 p NM_005430.3 NP_005421.1 28 GRASP 50687714 p NM_138894.1 NP_620249.1 29 STAT2 55040515 m NM_005419.3 NP_005410.1 30 PXN 119165946 m NM_001080855.1 NP_001074324.1 31 APEX1 19993856 p NM_001641.2 NP_001632.2 32 FOS 74816285 p NM_005252.3 NP_005243.1 33 AKAP13 83724944 p NM_006738.4 NP_006729.4 34 NFATC1 75256048 p NM_006162.3 NP_006153.2 35 NFATC1 75257310 p 36 NFATC1 75257866 p 37 CCNE1 34995795 p NM_001238.1 NP_001229.1 38 PLCG1 39198934 p NM_002660.21 NP_002651.2 39 PLCG1 39199498 p 40 NCOA3 45564099 p NM_181659.2 NP_858045.1 41 MAPK1 20545893 m NM_002745.4 NP_002736.3 42

In a further embodiment the invention relates to a method wherein the primary and secondary datasets comprise methylation data and wherein the functional nodes represent genes which are hypermethylated and/or genes which are hypomethylated.

In a further embodiment the invention relates to an assay according to the second aspect of the invention for analysing an expression pattern of said genes, such as room temperature polymerase chain reaction (RT-PCR), RNA sequencing, gene expression microarrays.

In a further embodiment the invention relates to an assay according to the second aspect of the invention for analysing a methylation pattern of said target nucleic acids, such as by using methylation specific PCR (MSP), bisulfite sequencing, microarrays, direct sequencing, such as implemented by Pacific Biosciences(R).

To sum up, a method for assigning ranking scores to pathways in a set of pathways for classifying patients is disclosed. The method comprises the steps of comparing biomolecular datasets from different groups of patients and performing an analysis in order to assign ranking scores to pathways in a set of pathways. Furthermore, a method for using cancer pathway evaluation to support clinical decision making is disclosed. This assessment is further used for stratifying ovarian cancer patients based on chemosensitivity to platinum based drugs, the standard chemotherapy. We present the method for evaluation and ranking of the most relevant pathways responsible for platinum sensitivity. Clinical decision support software system should be able to then visualize this information for a clinician, contextualize it within a patient data set and help make a final decision on the potential responsiveness.

Although the present invention has been described in connection with the specified embodiments, it should not be construed as being in any way limited to the presented examples. The scope of the present invention is set out by the accompanying claim set. In the context of the claims, the terms “comprising” or “comprises” do not exclude other possible elements or steps. Also, the mentioning of references such as “a” or “an” etc. should not be construed as excluding a plurality. The use of reference signs in the claims with respect to elements indicated in the figures shall also not be construed as limiting the scope of the invention. Furthermore, individual features mentioned in different claims, may possibly be advantageously combined, and the mentioning of these features in different claims does not exclude that a combination of features is not possible and advantageous.

Example 1

Interrogating chemosensitivity in ovarian cancer patients using pathway analysis.

Description of the Data

Our goal was to find differentially regulated pathways based on methylation information from CpG island loci on a genome wide scale to study platinum sensitivity in ovarian cancer samples. We have processed 44 ovarian cancer samples, all grade III, histologically classified as serous carcinoma. The platinum free interval in our sample set varies from 0 to 112 months (see FIG. 1). The traditional definition for the platinum free interval categorizes patients with PFI less than 6 months as platinum-resistant and more than 6 months as platinum-sensitive. We performed a statistical analysis of the resistant vs. sensitive on the geometric mean of CpG island microarray data, which originates from a Methylation Oligonucleotide Microarray Analysis (MOMA). The inventors of the present invention have participated in the development of a CpG island microarray called MOMA: Methylation Oligonucleotide Microarray Analysis for the use of finding differentially methylated patterns in breast and ovarian cancer. The array, Methylation Oligonucleotide Microarray Analysis (MOMA) interrogates about 150,000 loci on 270,000 known CpG islands, across the whole genome for differential methylation.

In the context of the present invention, the term “CpG island” refers to a contiguous region of genomic DNA that satisfies the criteria of (1) having a frequency of CpG dinucleotides corresponding to an “Observed/Expected Ratio”>0.6, and (2) having a “GC Content”>0.5. CpG islands are typically, but not always, between about 0.2 to about 1 kb in length.

FIG. 1 shows clinical data: Platinum Free Interval (PFI) for all samples.

Statistical Data Analysis

Before applying pathway analysis, we start with a standard unpaired t-test, followed by clustering. We experimented with different levels of differential methylation change, and obtained a signature containing 5703 differentially methylated loci at p-value 0.05 and a fold change of 1.1. FIG. 2 shows the clustering dendrogram using the aggregate geometric mean signal value for the statistically significant differentially methylated loci between the resistant and sensitive groups.

FIG. 2 shows hierarchical clustering of all loci after a t-test (p-val 0.05) and fold change>1.1.

Although these are statistically significant loci, the subsequent hierarchical clustering on all the patients revealed a pattern that seemed to result in clusters that did not have big inter-cluster difference. Indeed, we observed that in our data set there is a continuum of PFI from 6 months onward up to 112 months, and we cannot expect that these patients (the ones between 6 and 30 months) to have a completely distinct molecular profile from the patients whose PFI is less than 6 months. Hierarchical clustering, on the differentially methylated loci obtained from a t-test where fold change is greater than 1.1 and p-value is 0.05 is shown in FIG. 2.

Pathway Analysis

Based on this initial set that describes the difference between resistance and sensitivity to platinum based drugs in ovarian cancer we performed pathway analysis using a commercially available tool in GeneSpring GX 10.0. The FindSignificantPathways tool was used to identify pathways that are critical in distinguishing between the early-resistant and sensitive samples based on the filtered fragment-list.

FindSignificantPathway takes an entity list (could be methylation probe IDs, or Affymetrix gene expression probes or identifiers that can be linked to an Entrez gene ID or gene symbol) as an input and finds all pathways from a collection which have significant overlap with that entity list. Here, overlap denotes the number of common entities between the list and the pathway. Commonness is determined via the presence of a shared identifier, i.e., Entrez Gene ID, or gene symbol. Once the number of common entities is determined, the p-value computation is based on the Hypergeometric method or the Fisher's exact test. The results are output as a table which shows the names of the pathways, the total number of nodes in the pathway, the number of genes from the input list that belong to the pathway and the p-value. The p-value shows the probability of getting that particular pathway by chance when this set of entity list is used.

Pathways showing significant overlap with genes (entities) in the gene list (entity list) selected for analysis are displayed in Table III.

FIG. 3 shows Wnt Pathway and functional nodes. The genes with blue halo are the 3 genes from the input list (cf. Table III) that belong to Wnt pathway. In FIGS. 3-5, the elongated elliptical entities represent proteins, the smaller circular entities represent small molecules and the larger entities which appear composed of two vertically elongated ellipsoids represent complexes.

Example 2

Interrogating tumor vs. normal samples using pathway analysis.

Description of the Data

We performed statistical analysis of normal vs. tumors on the geometric mean of MOMA data. We performed unpaired t-test, wilcoxon-rank sum test and a linear Bayesian model-based analysis with leave one out validation to identify differentially methylated probes. Similar pathway analysis as applied to resistant vs. sensitive patients (cf. Example 1) was applied to the differentially methylated probes.

Table II shows significant pathways distinguishing tumor vs. normal samples,

FIG. 4 shows inactivation of gsk3 by akt causes accumulation of b-catenin in alveolar macrophage,

FIG. 5 shows the PDGF signalling pathway deemed significant in tumor vs. normal analysis.

Description of a method according to an embodiment of the invention

FIG. 6 shows a flow chart according to an embodiment according of the invention where primary and secondary datasets 122 are given, which primary and secondary datasets may be high throughput data, representing gene expression or methylation data. Statistical techniques are applied in a method step S102 in order to identify stratifying features 124 in the primary and secondary datasets 122. As a result, a list of stratifying features 124 is obtained, which list may be a list of stratifying genes. Ranking scores are assigned to each pathway in a plurality of pathways in a subsequent step S104, which step results in a set of ranked pathways 126, said ranking being based upon the plurality of stratifying genes. For a pathway in the set of ranked pathways, functional nodes are identified in yet another step S106, which functional nodes may, for example, be statistically significant hyper-methylated or hypo-methylated nodes. This may form the basis of a visualization 128 of the specific pathway, showing the functional nodes in the pathway. Furthermore, the identification of the functional nodes may serve as input to an assay 132 for analysing one or a combination of the genes taken from the group consisting of stratifying genes which are also present in the pathway, i.e., functional nodes. The visualization 128 may itself serve as input to a clinical decision support system 130.

SEQUENCE LISTING DNA/AMINO SEQ ID NO ACID (AA) NAME SEQ ID NO 1 DNA DFFB_5613.251.385 SEQ ID NO 2 DNA POU2F1_38114.196.208 SEQ ID NO 3 DNA PRKCE_58777.69.739 SEQ ID NO 4 DNA COX5B_66677.156.156 SEQ ID NO 5 DNA STAT1_78664.744.82 SEQ ID NO 6 DNA STAT1_78675.465.377 SEQ ID NO 7 DNA PPARG_89713.688.826 SEQ ID NO 8 DNA RAF1_89798.41.889 SEQ ID NO 9 DNA RAF1_89805.297.451 SEQ ID NO 10 DNA CTNNB1_92989.616.164 SEQ ID NO 11 DNA RHOA_95515.752.164 SEQ ID NO 12 DNA TMF1_98978.256.430 SEQ ID NO 13 DNA TMF1_98985.584.264 SEQ ID NO 14 DNA GSK3B_101319.720.720 SEQ ID NO 15 DNA GSK3B_101331.594.482 SEQ ID NO 16 DNA PDGFRA_122302.371.217 SEQ ID NO 17 DNA LEF1_126420.93.619 SEQ ID NO 18 DNA HMGB2_131605.541.163 SEQ ID NO 19 DNA PPARD_169972.513.129 SEQ ID NO 20 DNA FZD1_203266.473.881 SEQ ID NO 21 DNA FZD1_203279.320.922 SEQ ID NO 22 DNA FZD1_203292.356.858 SEQ ID NO 23 DNA SET_258150.210.34 SEQ ID NO 24 DNA GATA3_268815.345.897 SEQ ID NO 25 DNA PTEN_280194.192.1014 SEQ ID NO 26 DNA CCND2_323251.49.807 SEQ ID NO 27 DNA LRP6_324917.684.126 SEQ ID NO 28 DNA WNT1_328477.74.612 SEQ ID NO 29 DNA GRASP_329986.258.986 SEQ ID NO 30 DNA STAT2_331937.18.838 SEQ ID NO 31 DNA PXN_340153.701.293 SEQ ID NO 32 DNA APEX1_358348.624.922 SEQ ID NO 33 DNA FOS_367165.85.551 SEQ ID NO 34 DNA AKAP13_389484.262.430 SEQ ID NO 35 DNA NFATC1_468453.516.496 SEQ ID NO 36 DNA NFATC1_468492.428.622 SEQ ID NO 37 DNA NFATC1_468505.763.77 SEQ ID NO 38 DNA CCNE1_494022.258.1004 SEQ ID NO 39 DNA PLCG1_521868.549.775 SEQ ID NO 40 DNA PLCG1_521883.758.704 SEQ ID NO 41 DNA NCOA3_523517.757.145 SEQ ID NO 42 DNA MAPK1_541414.423.597 

1. A method for assigning ranking scores to pathways in a set of pathways for classifying subjects, said method comprising the steps of distinguishing a plurality of primary subjects from a corresponding plurality of secondary subjects by means of a clinical parameter relevant to cancer, which differs between the primary and the secondary subjects, obtaining a plurality of primary datasets comprising biomolecular features from the plurality of primary subjects, obtaining a plurality of secondary datasets comprising biomolecular features from the plurality of secondary subjects, identifying a plurality of stratifying features (124) in the primary and secondary datasets, wherein the stratifying features (124) are biomolecular features which differ in a statistically significant manner between the primary and secondary datasets (S102), identifying a plurality of stratifying genes corresponding to the stratifying features, assigning a ranking score to each pathway in the set of pathways (S104) thereby providing a set of ranked pathways (126), said ranking being based upon the plurality of stratifying genes, wherein the step of assigning a ranking score to each pathway in the set of pathways comprises the steps of identifying a number of functional nodes in a pathway, the functional nodes being nodes corresponding to stratifying genes, identifying a number of hubs in the pathway, the hubs being nodes with a number of connections being larger than an average number of connections per node in the pathway, identifying a number of important hubs in the pathway, the important hubs being hubs with a number of connections being larger than an average number of connections per hub in the pathway, assigning a ranking score to the pathway, the ranking score being based upon a ratio between the number of functional nodes and a number of nodes and a ratio between the number of important hubs and the number of hubs.
 2. A method for assigning ranking scores to pathways in a set of pathways according to claim 1, wherein the step of assigning a ranking score to each pathway in the set of pathways comprises calculating a significance value for each pathway, said significance value being based upon a number of common genes between the plurality of stratifying genes and the pathway.
 3. (canceled)
 4. A method for assigning ranking scores to pathways in a set of pathways according to claim 1 for discriminating between normal and tumour samples in cancer diagnostics, wherein the clinical parameter describes a presence of a tumour.
 5. A method for assigning ranking scores to pathways in a set of pathways according to claim 1 for discriminating between normal and tumour samples in ovarian cancer diagnostics, wherein the clinical parameter describes a presence of a tumour in an ovary.
 6. A method for assigning ranking scores to pathways in a set of pathways according to claim 1 for predicting responsiveness of a subject with ovarian cancer to a therapy comprising one or more platinum based drugs, wherein the clinical parameter describes a sensitivity towards the therapy comprising one or more platinum based drugs.
 7. A method for assigning ranking scores to pathways in a set of pathways according to claim 1, wherein the ranking score for a pathway is given by a sum of a ratio between the number of functional nodes and the number of nodes in the pathway, a ratio between the number of important hubs and the number of hubs in the pathway, a gene set enrichment score, wherein the gene set enrichment score is based upon a comparison of the functional nodes in the pathway and a gene set comprising genes related to the clinical parameter, the gene set enrichment, score being indicative of a probability of having the number of functional nodes appearing in a database consisting of clinically relevant genes.
 8. A method for assigning ranking scores to pathways in a set of pathways according to claim 1, wherein the primary and secondary datasets comprise any one of: a DNA methylation dataset, a gene expression dataset.
 9. A method for assigning ranking scores to pathways in a set of pathways according to claim 1, wherein the primary and secondary datasets comprise methylation data and wherein the functional nodes represent genes which are hypermethylated and/or genes which are hypomethylated. 10-12. (canceled)
 13. A method for classifying a subject, said method comprising obtaining a subject dataset comprising biomolecular data of a target nucleic acid comprising one or a combination of the genes taken from a group consisting of stratifying genes according to claim 1 and their regulatory regions, identifying the pathway according to claim 1, which is assigned the highest ranking score, accessing a database comprising database values of the stratifying features corresponding to hubs of the pathway, which is assigned the highest ranking score, which is identified according to claim 1, calculating a subject classification score based on the difference between database values of the stratifying features corresponding to the hubs and values of corresponding features in the subject dataset.
 14. A clinical decision support system comprising an input for providing a subject dataset comprising biomolecular data of a target nucleic acid comprising one or a combination of the genes taken from a group consisting of stratifying genes according to claim 1 and their regulatory regions, a computer program product for enabling a processor to carry out the method of claim 15, an output for outputting the subject classification score.
 15. A computer program product for enabling a processor to carry out the method of claim
 13. 